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HomeMy WebLinkAboutMiscellaneous - 14 PLEASANT STREET 4/30/2018 14 PLEASANT STREET 210/055.0-0034-0000.0 Location 1 41 U) leaSAti T S No. Date NORTH TOWN OF NORTH ANDOVER - 3?O�,tN_o �_•,�O O 41 Certificate of Occupancy $ CMUs t� Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ TOTAL $ C?a 0 Check # 15887 Building Inspector .. I a TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: DATE ISSUED: ic SIGNATURE: A /1 �� G Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION 0 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1.3 Zoning Information: ! 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: n Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT M 2.1 Owner of Record PR Ut- Name(Print)U Address for Service: dztv�- C6�Sdc') 9-Co Signature Telephone 2.2 Owner of Record: Name Print Address for Service: O z M Signature Tel hone M SECTION 3-CONSTRUCTION SERVICES 7� 3.1 L- used Construction►� S rvisor: Not Applicable ❑ © Aid P6660b Licensed Construction Supervisor: 9V`� 7 a V O II —75 License Number A� y V61� Expiration Date icic St nature Telephone r f I 3.2 R i ed Home Im rovemen ntUStor Not Applicable ❑ v 6G� �l� Company Name I 5 m 7� LI CA��iu /f2 Cl, Add Registration Number Cr s l' Expiration Date /1 Signature Telephone !�/ T SECTION 4-WORKERS COMPENSATION(IYLG.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......❑ SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: t - l lJ SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be aFFICL USE ONLY:s x CoMpletedbypennit applicant 1. Building QD (a) Building Permit Fee 7�V Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, &OMM as Owner/Authorized Agent of subject propert Hereby declare that the statements information on the foregoing application are true and accurate,to the best of my knowledge and be/ �1.� All, C �r, I® POAdJ06aj Print Na /j I/ 102— Signature of Owner/Aent Date SEE=171-7-MA, a 131 .W� NO. OF STORIES SIZE BASEMENT OR SLAB RD SIZE OF FLOOR TIMBERS 1 s 2 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS s DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHI10NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE w •,a. •rra �G'omtfl[RtPW' � p°r�QaSSaL�LSfs�S • _I D�asi77r�p'clnt{srstriaG.�irt�ett�s • c i _ ,�'r_:� Q�f ZGC�lTi'U:.17T�6�.YDT13' 600 Was&nff=.street • Yicrkess'Compcnsaiian Insurance Amitasrit • APPLIC _ 0 'j�TI N' Please?�II�IT Legibly.!. Name: A 6 Gtr A.) Location: R f City' U Telephone n: (, �7 �/ C/ ❑I Mn a homeownerpm!m=mg aE wcrkmyseii ❑ i am sole prouristor and have no one worlang m my caflacitV D I am an employer providing workers' compensation for my employees worldng an this job Company Name: Address: City: Tr r- h===5 C=732ry: Policy D I am(circle one) sole propriill ,general cOntraeto homeowner and have hired the contracTors lisud'nelow who have the following. worirers' campensatian polic -F2 j 'f� D F fi` - Company Naane: Address: it UJ�C Ci YM ' /'�'1S� Teiephaae ; in��rance CDmpa�Sr•- /` X( L'/V /VI .Policy r.; -ZPJ Q& /• //� /.J Company Nam Address: City: Tei-phone : Insn�aee Company: Polley Attach additiozbai sheet if necessa-,7 Failzo secure coverage as squired under Section^5A of MGL 15B canlead to the imposition o?criminal penalties of a fine up To 1150C ure and/or on:years' irnprisonmcnt as well as civil penalties in the in=of a STOP WOPX,ORDER and a fine gf S100.00 a by agaiwt m . I under-mnd that.a copy of this smiement may be forwarded to the 0mce of lnvestigatiens of the DIA for coverage veTincation. 1 do hereby cc under the pains axil p aloes of perjury that the information above is true and correct Date: 23/6 Z vi Priv_Name: Phone 4 Oxuciai Use ONLY Do notwrit:in this area D Bulidino Denartnent Cii) or"town: D Licensing Board M Selectmen's Omee D Health Department D Other M Check If Ir-nmeriiate response is required I TNWOPJY.SY_.9.1O &i.. sm1i cT1®SNTS- u -7 e ac its - , Klass hus � a . General Laws chapter 1�_ s�ction_�requires 311 hap quzz to err to Ovide workers com - �P Y Fr ansanon a as "law" p for their ='Plovees• As quote from the law' an'em to ee is define a a a e. _ 4u p y vfmn�d as --very person in t}m. Service o, another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association,.corporation orother legal entity, or any two or mare of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, ar the receiver or trustee of an'individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides 'therein, or the occupant of the'dwelling house of another who employs persons to do maintenance, construction or repair work.on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.employment be deemed to bean employer. MOL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth moi any applicant who has not produced acceptable evidence of compliance-vAth the insurance coverage required. _g.dditionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of.public work until acceptable evidence o f complianceit v -the±mzance requirements of this chapter have.beetyre5ented to.the contracting authority. Applicants Please nll in the workers' compensation affidavit completely,by checking the.box that applies to your situation and supplying company names, address and phone numbers as all affidavits may be submitted to the. Department of Industrial Accidents for.connration of insurance coverage. Also-be sure is sign and. date the aMdavil" The affidavit should.be returned to the city.or-town that the application for the pee Lentz license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the "law"-or if you are required to.obtain•a workers':compensation policy,please call.'the Department at Erle number Listed below. Cid or Towns Please be sure that the affidavit is complete and printed legibly. The Deparanent has provided a space at the bottom of the affidavit for you to fill out in the event the Of r,5 of Investigations has to contact you,regarding the applicant. .Pleast.bt sure to X11 in the pe=Jtllicrose number which will be used as a reference numbef. Tae afndavits znay be returned to the Jeparazsent by mail or FA-'K,unless other arrangements have been made. The Office of investigations would lake.to thank you in.advance far your cooperation and should you have any questions, please do not hesitate to give us a call. The Depart rent's address, telephone and fa= number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations 600 Washingaton.Street . Boston,IYLA CZ111 rar (617)727-7749 Telephoner (617) —2-7-4900 est. 406;409, o-, 375 ✓fip, �amrmro�uuna� o�'./l'��aa�u6�,lld 3 Board of Buiidirg Regulations-)Pd Standards ! NOME IMPROVEMENT CONTRACTOR . { 111 \ Registration: 125502 Eic lration: 1004 i ' Type: DBA RONALD P.GAGN61`4 RONALD GAGNON 75 COCHRANE CIRCLE-A t:1ETHUEN,10A 01844 ArtR n?ser^sar - � ✓/te TDo-m»ta�tu�etrll� af's��[�.Wtzc/ru�sejls E - r r BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS j 075384 r Birthdate: 10/02/1949 Expires: 1010212002 Tr,no: 75384 Restricted To: 00 i RONALD P GAG NON , ON 75 COCHRANE CIRCLE « f i METHUEN, MA 01844 ? . Administrator Town . dover O o� �o�„,' � dower, Mass., ORATED S H ti BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �+•c BUILDING INSPECTOR THIS CERTIFIES THAT...pr*01114041VV�... ..*;�e........�...`. 1............r............... ................................. Foundation has permission to erect... .� .�.�............ b ildin son..../.7..... Jr.e3 .��.....�� • Rough to be occupied as..... 1. ....... !!.��......v` '�re��� fUr I #Ow Chimney p s .� ...... ...44044 .. ............................................. provided that the person accepting this permit shall in every respect confo to the terms of the application on file ° mal this office, and to the provisions of the Codes and By-La s relating to the I spection, Alteration and Construction S%�.f Buildings in the Town of North Andover. s�0 ” o o ® PLUMBING INSPECTOR 3y a VIOLATION of the Zoning or Building Regulations Voids this Permrt. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STARTS ELECTRICAL INSPECTOR C Rough . ................................... Service 00 BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 3227 � Date. ..©-..'. . . ........ f a HORTM TOWN OF NORTH ANDOVER41 Q a? ^ PERMIT FOR GAS INSTALLATION f D �,SSACHUSES This certifies that r . . . . . . . .„/ . ?.6/. . . . . . . . . . . . . .. has permission for gas installation-�. . . :G"i . . . . . . . . . . . . b. in the buildings of . . . fyj`G: . ..- . . . . . . . . . . . . . . . . . . . . . . . . .9 at /.�1. . > . . . . . . � . , North Andover, Mass. Fee . �!. . Lic. No.".'!�. --GAS INSPECTOR WHITE:Applicant CANARY: Building Dept. PINK:Treasurer MAPS I > PARCEL 0 MASSA DCATON FOR PERMIT TO DO GAS FITTING f ype or print) Date �/�.�� 19 NORTH ANDOVER, MASSACHUSETTS Building Locations /T 11� �aC/ S Permit 4 a 0'/ Amount S Owner's Name � �JPA New❑ Renovation ❑ Replacement L" Plans Submitted ❑ 1 � n Cn Cn C m cc Z w % `" : Z SUB -BA SEN( E :NT B A S E vt E N T 1 S T. F L O O R 2 N D . F L O O R 3 R D . F L O O R 1 T H F L O O R 5'r If FLOG K 6T 11 F L O O R 7T 11 FLOOR 8 T H F L O O R (Print or rype)n, 1 Check one: Certificate Installing Company Name F1 Corp. 1� Address Z J`u 0�ej Aj r 51J' Z�L / l� ❑ Partner. Business Telephone 6 :� 7 ,9 ' Firm/C o. Name of Licensed Plumber or Gas Fitter 1?( U L���/i SVy Ity INSURANCE COVERAGE Check one: 1 have a current liability Insurance policy or it's substantial equivalent. Yes ❑ No❑ Ifyou have checked ves, please indicate the type coverage by checking the appropriate box. Liability insurance policy �_ Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent \ Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed fujr Or Gas Fitter Title © Plumber . l USS City/Town ❑/ Gas Fitter LiceXse Nu ❑ Master APPROVED(OFFICE USE ONLY) ❑. Journeyman Location �_ .11 Date g a3� 19'9 NORTF� TOWN OF NORTH ANDOVER h? • • Op Certificate of Occupancy $ 4L I Building/Frame Permit Fee $ a �'�''^•°''<�' cMuFoundation Permit Fee $ sswsa Other Permit Fee $ Sewer Connection Fee $ �► Water Connection Fee $ TOTAL $� c� 1 gD� Building Inspector 12 9401/04/99 12:40 25.00 PAID Div. Public Works PF-RMITNO. APPLICATION FOR PERMIT TO BUILD***** **NORTII ANDOVER, MA 1 hi%I,No . ��(� LO'1'.NU. U5� 2. RECORUOFOWNLI(SIIB' DATE BOOK PAGE MUNE SUB I)IY. LUI'NO. I.D(:AIION 14 PLIKSAAJT- SS- PURPOSE,(NBUIIDING � �� � ��� SF�tLL; AAJi-ACif (AVNLR'SNAME: k AcSsly' k,-m- - STlw-c— k�,/� NO.OFSFORIES SIZE OWNER'S ADDRESS S v CuW BASEMENT OR 51.A8 ST ND RD ARCI Ill E(-I'S NAME SIZE OF FLOOR TIMBERS 1 2 3 Brill DEN'S NAME SPAN DISTANCE TO NEAREST'BUILDING DIMENSIONS Of SILLS DIS FANCE I ROM S TREE 1' DIMENSIONS Oi:POS IS DISTANCE FROM LOT LINES-SIDES REAR DIMENSIONS OF GIRDERS AREA OF LOT FRONTAGE I IEIGI IT 01:FO(JNDATI(NI THICKNESS IS BUILDING NEW rV d SIZI OF_I(X)rLING a X IS BUILDING ADDII'I(N4 u V I-IAIERIAI.OFCIIIMNEY IS BUILDING ALTERATION R�p>�(Z 'S)'� A.t-,k IS BUILDING ON SOLID CTFZTILLED LAND WILL BUILDING CONFORM TO Rt:CKJIREMENI S OF CODE tS IS BUILDING CONNECI ED I'O TOWN WATER 43OARD OF APPEALS ACTION, IF ANY IS BUILDING CCNJNECIED TO TOWN SEWER L S IS BUILDING C(NJNECIED TO NA(URAL GAS LINE )'1V6111CTIONS 3. PROPERTY INFORNIA'FION LAND COSI' tl a� - EST.BLDG C()6T iPAGE I FII �rc EST. BLDG.COSI PER SO.FT. I. TSECTIONS I-3 n jESI. Bl.lk'.i.COS Tl'ERROOM EI ECTRIC N10 ERS MUST BE ON(XITSIDE OF BUILDING SEPTIC PERMITNO. 'e AI-IACIIEDGARAGESMIJSTC(NJfoRm FOSTAIEFIRE RE(;t)I.A'1'1ONS a. APPROVED BY: PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR BUILDING INSPECTOR DA 1'f.FII.F.D /� 3/ / OWNERS T El.a.: A CO NJ'IRA1-0 rwt C(NIlR.1.IC'fI ,IGNATLIRG oI 01A NER()R Atli I IORIZTil)AGL1'll ' -4-- �- HE I'I RAII I GRANITI) a 19 - F MORTy Town of _ _ over o m No. Own i�- * dover, Mass., 19,70 KE A O'9A_CO CHICHEWICK q4 TED PPP t J (G -` BOARD OF HEALTH Food/Kitchen PERMIT T Septic System O 1 �G �O• BUILDING INSPECTOR w-e THIS CERTIFIES THAT... ............. ............................ ...�.7.... ............................................. Foundation j4 Q I r buildings 1P/V*45A .. Rouhas permission to ereet�-. 0. g y....... g, to be occupied as DOE *� �r��t V �a' Chimney ............... .........�.�........................................ /......�,.5.................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR `AVIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR a� UNLESS CONSTRU T� T� Rough ............ . ....... ....,.............................................. Service .... . .. - - BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — ,Do Not, Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. Smoke Det. I TOWN OF NORTH ANDOVER i AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: p°ViL ! rrvL4 e,-, A4-AGL- Est. Cost 1 L �L�s>'�X s-T- Address of Work � Owner Name: PrZ.°'C-rZS5kI/a, Cu Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied V-Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND LINER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name g Date. ......5.7� N2 2 179 .... .. ... .. . ...... TOWN OF NORTH ANDOVER 0 t- — — y PERMIT FOR WIRING 4 S C$4us This certifies that .... ...........10 ......... c ............................... . . . .. ........ .. ................... has permission to perform................ ........ . . . ......................................... 11;71 . ..... ...... -4ring in the building of....I...... ................... ........ j at... ............................................. . ......................... .North Andover,Mass. Fee". .............. Lic.No.�......... ............................................................... ELECTRICAL INSPECTOR WHITE: Applicad?""9WWY: B.ildingb%AP PAIPINK:Treasurer THEC0AM0AWE4L7H0FA145SACHVVM i OfficeUseonly DEPARTAMWOFPUBLICS4FM Pemtit No. �Q11�'/9 BOARD OF FIRE PREYEM70NREGUTATI01�S R7 CMR ' Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / ✓ / Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) � %y�"V//— 57 Owner or Tenant ('e Owner's Address—LIOIA Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA N6.of Lighting Fixtures Swimming Pool Above Below Generators KVA groand ound Nr�.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained _ Detection/Sounding Devices No.ofyers Heating Devices KW Local Municipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHE C C f/l C U/ r1 lrwra=Co a� P,rsuatttirtthem manaltsdMasodaaettsCo Corral Laws Iha-.eaaratLiabibtylrmrd=PobcytncLd%C mplde C mageoritssizbnfaie4ivalatt YES NO Iha,,eab ttiedNohdptoofofsamiotkte06rc>r YES F-1 Ifjwha%et3rJsedYESspieasee±c*theNxof naWbyc mkngthe Tprcpriaebcx INSURANCE BOND F'—J OR ER F-1 Flease may) Expiratim Date Estima l VakrdEk iral Wads S WcikioSlatt InspemtxtDW-Ra4xsted Ratgh FRMunaerm NAME �2�-- �('�—C_ /J, B4���Lioa�see `2lGl �� �`l Stgt�n,re LieNo {r BusinessTd.Na �Po �Co 9 7 b' /=2� /l� �'- G Al Tel Na OWNER'SINSURANCEWAIVER;Iartawatetha drLiomsedoest�oth�etheir>yuaneo orilss le�mala>tasraltmedbyMassada sGeneralLaws and ditmy aeorithispalnHapp6aatiwaiwsthisre#nnert J .(Please check one) Owner Agent Telephone No. PERMIT FEES �� No 2164 Date .......... r Pht TOWN OF NORTH ANDOVER PERMIT FOR WIRING ,sSACHUS L 7 � � This certifies that .( .................' � .......................t. ....................................... has permission to perform wiring in the build ------�- ..... ........... .North Andover,Mass. .... ...... ..... Feed.Z5.............. Lic.No.\:!�.. ............ELEc...rRICAL.INSP........ECrOR................. 12/10/98 13:30 15.00 PAID WHITE:Applicant CANARY: Building Dept. PINK:Treasurer THEC0W0AW 4LTHOFMAMARS= Office Use only DEPARTNIDVTOFPUBLICSAFE7Y Permit No. BOARD OFMEPREYEMONREGUL4770AS527CMR 12. �5 Occupancy&Fees Checked AUPPLICATION FOR PERA T TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date f ` ! O Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work d scribedblow. Location (Street&Number) /�L Owner or Tenant Owner's Address `� Is this permit in conjunction with a building permit: Yes rl No r7 (Check Appro ate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts OverheadEl ED Underground No.of Meters New Service Amps / Volts Overhead [= Underground No.of Meters Number of Feeders and Ampacity Loca,51 and Nature of Proposed Electrical Work No.of-righting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA ground ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No of Disposals No.of Heat Total Total No.of Detection and Pumps Tons KW Initiating Devices No of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No c' Jryers Heating Devices KW Local Municipal a Other Connections No o0Varer Heaters KW No.of No.of 7 Signs Bailasis No Hydro Massage Tubs No.of Motors Total HP OTHE • CC� r-�-t(It� civ „10 eQul t.. C' hrnrarceC Plast�arY9�theraglmanats use>$GataalLam I haw a arrre t Liability hwxarm Pbby. indu>ding Cm#A Co�e-ageor its akswtial egiv-, at YES NO Ihave akmmdvalidpmofofsanebtheOffioe.YES a lfj(uha%edxdwdYES,plr"hdic*thetypeofdmrdWbydrda-lgdr INSURANCE C:� BOND = OTHER Fe"Spacfy) Fstc�value d'Elecrical work$ Wad:ID Start h>, xtien D*Reg xsted R/oug'h Fetal SignedutxierE 4 n \\ FIRM NAME // ��',��_/►� Liomse% J Lxa e�l C•C�✓"^`� Sig ueYLio wNo , Btsiress Tel.No. 9 �—/LW l j'' 9&u� C-06—2, AIL Tel Na OWNER'S INSURANCE WAIVER l am mN= theL=w dm not them arneeovaaWords WjmtW aFnakr tas m4 mW byMasdaseas anal Laws and that my srgnatueeon this pwnit applcafion wanes this reternat. (Please check one) Owner a Agent a0 U Telephone No. PERMiT FEE$ Office Use Only-, Ru�1E LIIIIITIIIIIIlUpIIi I of AFtliflar4imitt Permit Ivo. TiBepartrunt of'f uhlic �fetg Occupancy&Fee Check �, 3/gp (leave blank) U 3 Z�� BOARD OF FIRE PREVENTION REGULATIONS 527 CIMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cade, 527 CMR 12:00 —7 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / (X* or Town of NORTH ANDOVER To the Inspector of Wires: The udersigned applies for a permit toAZ m the, electrical work described below. Location (Street 3 Number) `Z/— o _ / C . Owner or Tenant �/z�J�►�l�' (� �' P Owner's Address ` 14 EVZCA"'/ uildin permit: Yes No (Check Appropriate So xj Is this permit in conjunction with a b 9 . � G t,`� S Utility Authorization No. �U® " 31o �rpcse of Buifdina � Existing Service e''' 0 Am /' 17 ps 'O?C/J 6*�Yorvcits Overhead Undgrnd No. of Meters • New Service '7 0 Amos ��d' , ) Vaits Overhead Uncgrna No. of Meters 7,�G► alaL 14 (t � � 00 Glxllf 4 c-- Numoer of Feeders ono Ampacity Location and Nature of Proposed Elect~cai L'leri< Total No. of Lignang Outlets No. of Hct -.:bs I No. of -ransformers KV•A Abover— In- No. of Lighting Fixtures i Swimming ?cot I Generators KVA L 5 9 grna. _ gr-, _ No. of Emergency Lighting No. of Pecectacie Outlets No. of Oil ourners i Barery Units I No. of Switc't Outlets No. or Gas Surners FIRE ALARMS No. of Zones I Total No. of Detection and No. of Ranges ( I No. of Air C°nc. tens Initialing Devices Heat Tctai Tota: No. of Disposals NO°t y PuT^s Tans K'.V No. of Sounding Devices No. of Self Contained No. of Oisnwasners - SoaceiArea Heating K�'J oetec;,on/Sounaing Devices I L — Municipal —Other No. of Dryers Heauna Cev:ces `r+'J scat _ Oannecc:on No. of No. of Low Voltage No. of Water Heaters KVJ I Sicns Ballasts Wir:nc Na. :Hydro Massage Tubs i No. of Motors Total HP oTHEa: S Z 401,(/t C� INSURANCE CCVERAGE: Pursuant to the reau:rements of Mtassacnusers general Laws _ I have a current Liaciiity Insurance Policy inctucing Co tec Operations Coverage or :ts suos:antial e4uivatent. YES NO — I vc^ NO _ it you nave Cheaxed YES. please indicate :he type of coverage Cy nave supmttted valid Arcot of same tot he Office. .ES checxing ,he agplacriate cox. INSURANCE BOND = OTHER = (Please Scec:ty) (Expiration Catel Estimated Value of E'.ectncal Work 5V G� Werx :a Start J h FinalInscec on Date Racues:ec: RouFinal ay g Signed unser , e n es of erlu ��1 /^ tic. NO. F7RM NAME LIC 7� LSignature Licensee us. Tet. No. Alt. Tel. No. Address OWNER'S INSURANCE WAIVER: I am aw a that the L:cens a aces not nave the insurance coverage or its sugstannal eaurvaienAt onto duwred by Massachusetts General Laws. ana that my signature on :hos permit application waives this reau:rement. Owner g� IP!ease cnecx ones 'etecnane No. PERMIT FEE 5 ISignature of Owner or Agenn :moo' .T ,. Date.......; .2. .. .. 1 r~ 726 ,,ORT#1 o? �o0 TOWN OF NORTH ANDOVER 41 PERMIT FOR WIRING This certifies that f � Y........ ...:...:...................:.: Oo ua-.� has permission to perform ; �...0 ... s....�!n{. .. r ... �, wiring in the building of at... ....7........ /. r ................................... ,North Andover,Mass. CM Fee.:................... Lic.No. ...................................... ...... ELECTRICAL INSPECTOR WHITE: Applicant CRNA&: Building Dept. PINK:Treasurer